We have instituted routine dynamic Intensity Modulated Radiation Therapy (dIMRT). This is the most complex of IMRT treatments and requires considerable pre-treatment verification to ensure accurate execution. These treatments are delivered using our twin Clinac-21EX accelerators. A Hi-ART system (Tomotherapy Inc.) for delivering treatments via helical tomotherapy has been installed, accepted and is currently treating patients. This system provides ROB with cutting edge treatment technology to support future clinical trials. We have started a series of initiatives with our Nucletron High Dose-Rate Afterloader (HDR) , using a small, high intensity 192Ir source for interstitial and intercavitary brachytherapy. Our radiosurgery capability has been expanded with the acquisition of 3 new applicators with diameters of 5mm, 7.5mm and 10mm. A new Philips Brilliance 16 slice, large bore CT Simulator has been installed and is operational. On-board imaging (OBI) has been installed on the newer Clinac-21EX. The final component of the Varian RPM Respiratory Gating system for providing gated radiation therapy has been acquired and we are awaiting delivery. Respiratory gating will improve targeting ability by compensating for regular respiratory motions during treatment. We have installed a major upgrade to our Tomotherapy system consisting of a new treatment couch which provides motorized lateral adjustment and a more rigid patient table. This couch also provides adjustments in 1mm increments which makes it suitable for some radiosurgery applications. ROB is in the process of adapting our current Radionics SRS head frame system to Tomotherapy. A new patient and image management system, ARIA, has been installed and is working well. On-board imaging has been added to the newest Varian accelerator. This provides diagnostic quality images, which makes anatomical and fiducial matching much more accurate. This is especially useful for prostate patients. All treatment planning systems have been upgraded with current hardware.We have instituted routine dynamic Intensity Modulated Radiation Therapy (dIMRT). This is the most complex of IMRT treatments and requires considerable pre-treatment verification to ensure accurate execution. These treatments are delivered using our twin Clinac-21EX accelerators. A Hi-ART system (Tomotherapy Inc.) for delivering treatments via helical tomotherapy has been installed, accepted and is currently treating patients. This system provides ROB with cutting edge treatment technology to support future clinical trials. We have started a series of initiatives with our Nucletron High Dose-Rate Afterloader (HDR) , using a small, high intensity 192Ir source for interstitial and intercavitary brachytherapy. Our radiosurgery capability has been expanded with the acquisition of 3 new applicators with diameters of 5mm, 7.5mm and 10mm. A new Philips Brilliance 16 slice, large bore CT Simulator has been installed and is operational. On-board imaging (OBI) has been installed on the newer Clinac-21EX. The final component of the Varian RPM Respiratory Gating system for providing gated radiation therapy has been acquired and we are awaiting delivery. Respiratory gating will improve targeting ability by compensating for regular respiratory motions during treatment. We have installed a major upgrade to our Tomotherapy system consisting of a new treatment couch which provides motorized lateral adjustment and a more rigid patient table. This couch also provides adjustments in 1mm increments which makes it suitable for some radiosurgery applications. ROB is in the process of adapting our current Radionics SRS head frame system to Tomotherapy. A new patient and image management system, ARIA, has been installed and is working well. On-board imaging has been added to the newest Varian accelerator. This provides diagnostic quality images, which makes anatomical and fiducial matching much more accurate. This is especially useful for prostate patients. All treatment planning systems have been upgraded with current hardware.